Name(s) making a pledge *
Pledge Amount * $10,000$5,000$2,500$1,000
Total amount of pledge *
This pledge will be paid when within 30 days after Harmony Medical Foundation receives 501 (c) tax exempt status which is projected to be by 1/31/2021.
Signature *
Date *
Address *
City *
State *
Zip code *
Phone *
Email *
Please make check payable to Harmony Medical Foundation
112 Harmony Crossing, Suite 4
Eatonton, GA 31024
